=Gavage= is forced feeding by means of a tube. A soft rubber catheter or tube, about No. 7, French scale, is lubricated with albolene, vaseline or sweet oil. The upper end is connected with a small tube or glass funnel holding two or three ounces. The child is laid upon its back in the arms of mother or nurse, the baby’s arms are held and the head steadied. In case of diphtheria or scarlet fever, the tube may be passed through the nose and down the pharynx and into the œsophagus five or six inches, or even into the stomach. It is more convenient and easier when possible to pass it through the mouth directly into the stomach. The food is then poured into the funnel, which, by elevation, empties itself into the stomach. If regurgitated, more food must be given. When withdrawn, the tube should be pinched to prevent leakage into the trachea. [Illustration: Fig. 122.—Apparatus for gavage or lavage. (Tuley.)] The great danger in these cases is the ease of overfeeding. =Lavage= or washing of the stomach may be performed in the same way with the above apparatus, when necessary. As soon as the stomach is filled, the tube is lowered and the fluid siphoned out. CHAPTER XX THE CARE OF THE CHILD (Cont’d) =Tongue-tie= is not met with so frequently as in the old days. If the child can suck and nurses energetically, this complication can be excluded. It may, however, occur. In such a case, the frænum is unusually broad and seems to extend clear to the tip of the tongue, which apparently is bound down to the gum and to the floor of the mouth. The thin membrane may be snipped with the scissors close to the tongue and then torn back with the finger. =Harelip and cleft palate= interfere with nursing and require continual attention to keep mucus out of the throat. Brophy has a rubber flap placed over the nipple of the bottle in such a way as to occlude the split tissue and thus enables the child to get nourishment. These babies must be fed systematically by gavage, if necessary, until the deformity can be repaired. =Hernia= at the navel is a common complication of infancy. It is not due to crying, to improper tying of the cord, nor to neglect by the nurse, as frequently charged. It is a congenital fault, wherein the cord opening does not close, and in time, crying and straining will drive the intestines out of the aperture like a pouch. The defect is revealed by the bulging outward of the navel when the child cries. Ordinarily the breach will close of its own accord. [Illustration: Fig. 123.—Cleft palate nipple. (Brophy.)] [Illustration: Fig. 124.—The device for feeding the child with cleft palate at the breast. (Brophy.)]